Clinical medicine (London, England)
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Since 2018, there has been no requirement to bring decisions about the withdrawal of clinically-assisted nutrition and hydration (CANH) in patients with persistent disorders of consciousness before the courts, providing that the requirements of the Mental Capacity Act 2005 (MCA) are fulfilled. Subsequent British Medical Association and Royal College of Physicians guidance on CANH withdrawal recommended standards of record keeping and internal and external audit to ensure local decision making was compliant with the MCA to safeguard patients. The scope of the guidance also included patients with stroke and neurodegenerative disorders. ⋯ Neither is the Care Quality Commission reviewing these decisions, as there is 'no statutory requirement' to do so. It appears there is a lack of organised scrutiny of these highly complex life-ending treatment decisions. This omission must surely be a cause for concern.
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The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) decided that its 2011 recommendations on consent for blood transfusion needed to be reviewed and revised due to evidence of poor compliance and recent legal guidance on consent. The recommendations are to ensure that patients are informed about and understand the purpose, benefits and potential risks of transfusion, and have an opportunity to discuss their treatment options. They should be incorporated into local practices for all patients.
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The annual review of competence progression (ARCP) is a high-stakes assessment which all UK postgraduate trainees undertake to ensure competence progression. Previous evaluations of the effectiveness of the ARCP as an assessment have reported deficiencies in both validity and reliability, however, there has been little focus on the educational impact of the ARCP. We conducted a mixed methods case study involving questionnaire, interviews and a focus group examining the impact of the ARCP on a respiratory higher specialist training programme. ⋯ Concerns were raised that the process promoted a reductionist approach to education. This research has resulted in several changes to local training, however, it has potential implications for the ARCP as a wider process. Trainers should be cognisant of the shortcomings of assessments and their impact on trainees, training and the future of the profession.